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cUU/•UCL•V5 1u:40 Aft vaC1T1C uaS ana tleciric l0 n')-n3.04G0 ci3 <br /> . I <br /> APPLICATION FOR INCROACMMNT PERMIT <br /> PLEASE PRINT: <br /> Date :_ 09VICE V5E ONLY <br /> To; San Joac(uin ,Ccunty JOB # l✓D�Z� pFF # <br /> Department of Public works APN � #-- <br /> ( o <br /> EXP. DATE <br /> (. • rV v--yG ti VALID /o_ IF-07 TO <br /> T (Applicant Na- STREET <br /> AREA `osq/ QUAD <br /> I. � y`i c`7 , •� TYPE � <br /> (Mailing Address) FORMS <br /> NOTE ; <br /> (City, State, Zip Code) � <br /> (Ax'ea Code �, 'Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to,excavate, con t: ct and/or <br /> a <br /> otherwise encroach, On County,Highway Right-o£-Way Qa the l� side of <br /> R��- �LD approximately <br /> of y—e�:l kg the <br /> r6afollowin work (description of waxy) : v W �^ �� � <br /> - _FIFE, <br /> Tc <br /> work willcommence on ox about for approximately <br /> Clays <br /> 1, the undersigned cert:�fy that I am the owner of the respective praperty, or am <br /> qualified to zepreeent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of can �7oaquin County and subject to <br /> inspection and approval . <br /> Sign tura of Applicant - Title Data <br /> .P8\gBC1�L (6/06) <br />